Difficult weaning from ventilation and extubation failure are major issues in intensive care, concerning 30% and 12% of patients respectively. These can be partly explained by the lack of accuracy of spontaneous breathing trial (SBT) failure criteria to predict extubation failure. The investigators performed a pilot study to evaluate transcutaneous carbon dioxide pressure (tcPCO2) monitoring during SBTs. The results showed that the difference between maximum and initial tcPCO2 (or ΔtcPCO2) was significantly higher in the group of patients who failed SBTs according to the usual criteria. Moreover, the results suggested that ΔtcPCO2 could be an accurate and early criterion for SBT failure. The size of the study could not examine ΔtcPCO2 regarding extubation failure. Therefore, the main objective of this study is to determine if Δ tcPCO2 during SBTs is associated with extubation failure.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
130
tcPCO2 continuous monitoring during spontaneous breathing trials
CH Versailles
Le Chesnay, France
Difference between maximum and initial tcPCO2 (ΔtcPCO2) during SBTs in patients who fail extubation compared to patients who have been successfully extubated.
Extubation failure: need for reintubation, rescue non invasive ventilation or death within 7 days following extubation
Time frame: 7 days
Association between ΔtcPCO2 and extubation failure after adjustment on post extubation ventilation protocols (preventive non invasive ventilation or preventive Optiflow)
Different post-extubation ventilation protocols may include preventive non invasive ventilation or Optiflow.
Time frame: 7 days
Association between extubation decisions and ΔtcPCO2.
Time frame: 1 week
Adverse Events associated with tcPCO2 monitoring.
Time frame: 1 week
Optimal ΔtcPCO2 threshold to predict extubation failure by a ROC curve.
Time frame: 7 days
Compare ROC curves obtained by different extubation failure predictors
ROC curves obtained with: * usual SBT failure criteria * deltatcPCO2 alone * usual criteria and ΔtcPCO2 combined * shallow breathing index * shallow breathing index and ΔtcPCO2 combined * ΔtcPCO2, shallow breathing index and usual SBT failure criteria combined
Time frame: 7 days
Determine if ΔtcPCO2 is an early predictor of extubation failure (happening before other criteria of failed SBT)
Time frame: 7 days
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